What is Fractures of the First and Second Phalanx?
These fractures of the first and second phalanx are the most common injuries suffered by horses who are being utilized for performance purposes. The fractures are chips, cracks or breaks in the bones that form the foot of your equine. The bones which are affected are the long pastern bone (first or proximal phalanx) and the short pastern bone (second or middle phalanx). This bone structure can be compared to the bone structure of the digits of the human fingers and toes.
Fractures of the first and second phalanx in horses can be defined as chips, cracks or complete breaks in the bones that make up the lower limb (foot) of the horse. These bones are located below the fetlock (ankle) joint in both the front and hind limbs of the horse.
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Symptoms of Fractures of the First and Second Phalanx in Horses
The most common symptoms of a fracture of the first and second phalanx in horses are pain and swelling in the area of the injury. Here are some of the things you will likely notice in your horse:
- Inability or reluctance to bear weight on the limb (toe-tapping, hopping or dragging the limb in question)
- Shock signs (sweating, elevated heart rate, anxiousness)
- The limb will not appear normal in size, shape, or angle
- Swelling in the area of the fracture (may or may not be present in every type of fracture)
- Bleeding will be present if there is a laceration or cut or if the fracture is open
- Loud popping or cracking can sometimes be heard by owner, handler or rider
There are many types of fractures to the first and second phalanx which are both possible and common to the pastern bones in general, especially to those in the lower limbs of a horse. While not an exhaustive list, here are some of more serious types of fractures of which your equine could suffer:
- Condylar fractures - A crack in the cannon bone (the long bone above the fetlock), can be complete and displaced or incomplete and nondisplaced; while not actually one of the phalanx bones, this can upset the alignment of the fetlock joint which can affect the phalanx bones
- Sagittal fracture - A crack the runs straight down the long pastern (first phalanx or p1) and can be complete and displaced or incomplete and nondisplaced; can be comminuted (shattered or splintered) usually caused by a sudden burst of speed
- Fractures to the short pastern (second phalanx or p2) usually occur as a result of the action of the equine when involved in sliding stops; hind pasterns are more often affected by this type of fracture than front pasterns
Any of fracture of any bone in the horse’s body can be complete (a total break in the bone which involves the blood vessel) or incomplete (a crack that is not full thickness which may or may not involve the blood vessel) and any fracture can be displaced (the pieces of the broken bone are not still in their normal alignment) or nondisplaced (the broken bone pieces are still in relative alignment without pieces migrating elsewhere). The degree of damage to the bone will dictate ultimate treatment.
Causes of Fractures of the First and Second Phalanx in Horses
Some fractures can occur in places you may think are relatively safe such as barn stalls or pastures and they aren’t always caused by stress and exertion in the execution of performance or pleasure tasks. Here are some of the causes of the various types of fractures:
- Injuries resulting from kicks from other horses or the horse kicking at stall walls
- Stress fractures (also called micro-fractures) occur from repeated high-stress exercise activities
- Sudden trauma, car accident, trailer accident, violent kick by another horse
- Racing injuries - a major category of causes - involves breakdown of the supportive tissue structure of the fetlock which allows unsupported bone to break or fracture
- Repeated stresses caused by racing, including those associated with sudden bursts of speed
- Fractures from execution of sliding stops
- Sharp turns or rocky terrain can cause some types of fractures
- Events for horses that involve jumping activities
Of paramount importance in regard to any fracture occurring to your horse is this: immobilization of the injured area needs to be utilized immediately upon the rider,handler, or owner becoming aware of the injury to prevent irreparable and irreversible damage to the limb. The longer the horse continues to move and use the limb after the fracture, the more damage can occur, some of which may not be fixable to allow the horse to be productive after the injury.
Diagnosis of Fractures of the First and Second Phalanx in Horses
The presence of a misshapen fetlock or limb coupled with the reluctance of the horse to bear weight and, perhaps, the actual popping or cracking sound when the fracture occurs will likely be the first signs noted. These observations will need to be passed along to your veterinarian as soon as possible. He will need to do a physical examination and final determination of the fracture will be obtained from radiographic imaging of the site of the injury. The radiographic imaging will likely be done from various angles of view to obtain the best imaging of the injury to enable appropriate diagnosis followed by an appropriate treatment plan.
It is vital that the injury be immobilized as soon as it is noted to prevent further damage to the bones and surrounding tissue, this step being utilized perhaps even before the arrival of the veterinarian. If you suspect a fracture, do not allow the horse to be moved without splinting the injury in some manner to avoid weight and motion to create more injury. This will aid the vet in his diagnostic process as well as this step will reduce the opportunity of additional tissue damage that could ultimately be part of the diagnosis.
Treatment of Fractures of the First and Second Phalanx in Horses
As you probably remember from watching the old Wild West movies, a horse with a broken leg was worthless and usually was killed. Thankfully, that drastic step is not needed in most cases for equine orthopedic injuries in this day and age. Treatment of the fracture, however, will be dependent upon the type of fracture, its location and the severity of damage to the bone and the surrounding tissue. As mentioned above, immobilizing the injury is essential to achieve the best diagnosis, care and prognosis for your equine. It might be in your best interests, both for the health and healing of your horse as well as for the financial investment you’ve made in the horse, to learn some basic emergency procedures to incorporate when an injury to your equine occurs.
These emergency steps should include the utilization of any of several types of splints and the recommended method of application of said splint so that you can address the immobilization of the injury more quickly, even before the arrival of your veterinary professional. This will significantly reduce the damage done to your horse from the injury which can quickly progress if the horse is allowed to continue to gallop, trot or run any distance after the injury has occurred.
The treatment plan recommended by your vet will likely include one of these splints at least initially and perhaps for several months. Depending on type of fracture and the extent of injury, surgical options will likely be recommended to:
- Remove fragments of bone which may have broken off
- To realign the bones or joint for proper healing position
- To insert screws and plates to hold the broken bone in an appropriate position while it heals
- Tissue repair or blood vessel repair in the event there is bleeding and torn soft tissue damage
- Casting of injury site after surgery or at least light bandaging of the injury site
Recovery of Fractures of the First and Second Phalanx in Horses
Sometimes the screws and plates inserted to enable the bone to heal properly are removed, while at other times, they will remain in place permanently. The orthopedic repair procedures which are currently being used are so advanced at this point in time that many horses will heal the break and the affected bone will be as strong as before the break. The opportunity for the horse to return to previous activities is very good provided the appropriate care is given as quickly as possible. You should expect that your horse will likely need 4 to 6 months of rest before a return to normal activities.
Fractures of the First and Second Phalanx Questions and Advice from Veterinary Professionals
My horse has DSLD that is quite far along. In the past few months I've notice what I think is his middle phalanx bone on his right front protruding. This week his leg is swelling is quite a bit and when I push on the bone it is painful. His pasturns are dropped and worse on this leg. Is it possible there is a fracture due to his stretched ligaments? I do work with my vet closely but have yet to ask her about this.
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